Testicular Cancer Treatment and Treatment Side Effects

Testicular cancer is almost always curable if it is found early. This disease responds well to treatment, even if it has spread to other parts of the body.

Staging

If a man has testicular cancer, it is important to find out the extent, or stage, of the disease (whether it has spread from the testicle to other parts of the body). Staging procedures include a thorough physical exam, blood tests, x-rays and scans, and, in some cases, additional surgery.

Most patients have computed tomography, also called CT or CAT scan, which is a series of x-rays of various sections of the body. Some have intravenous pyelography (IVP), x-rays used with a special dye to outline the urinary system. Some doctors recommend lymphangiography, x-rays taken with a special dye that outlines the lymph system in the abdomen. Ultrasonography, which creates a picture from the echoes of high-frequency sound waves bounced off internal organs, also may be useful.

Special lab tests can reveal certain substances in the blood. These substances are called tumor markers because they often are found in abnormal amounts in patients with some types of cancer. The levels of specific tumor markers in the blood can help the doctor determine what type of testicular cancer the patient has.

Surgery may be recommended to remove the lymph nodes deep in the abdomen. A pathologist then examines the nodes to see whether they contain cancer cells. For patients with nonseminoma, removing the nodes helps stop the spread of their disease. Seminoma patients do not need this surgery because cancer cells in their lymph nodes can be destroyed with radiation therapy.

Planning Treatment

Decisions about treatment for testicular cancer are complex. Sometimes it is helpful to have more than one doctor's advice. Before starting treatment, the patient might want a second opinion about the diagnosis and treatment plan. It may take a week or two to arrange to see another doctor. This short delay will not make treatment less effective. There are a number of ways to find a doctor for a second opinion:

• The patient's doctor may be able to suggest a doctor who has a special interest in testicular cancer.

• The Cancer Information Service, at 1-800-4-CANCER (1-800-422-6237), can tell callers about cancer centers and other National Cancer Institute supported programs in their area.

• Patients can get the names of doctors from their local medical society, a nearby hospital, or a medical school.

Methods of Treating Testicular Cancer

Testicular cancer can be treated with surgery, radiation therapy, and chemotherapy. The doctor may use just one method or a combination. Often, the patient is referred to medical centers that specialize in testicular cancer treatment.

• Surgery. In most cases, surgery is done to remove the testicle. Sometimes it also is necessary to remove lymph nodes in the abdomen. In addition, tumors that have spread to other parts of the body may be partly or entirely removed by surgery.

• Radiation therapy. In radiation therapy (also called x-ray therapy, radiotherapy, cobalt treatment, or irradiation), high-energy rays are used to damage cancer cells and stop their growth. Like surgery, radiation therapy is a local treatment; it affects only the cells in the treated area. The patient usually receives radiation therapy as an outpatient.

  Seminomas are highly sensitive to radiation. Following surgery, men with seminomas generally have radiation therapy to their abdominal lymph nodes.

  Nonseminomas are somewhat less sensitive to radiation. Patients with this type of cancer usually have other types of treatment.

• Chemotherapy. The use of drugs to treat cancer is called chemotherapy. Anticancer drugs are recommended when there are signs that the cancer has spread. Also, chemotherapy is sometimes used when the doctor suspects that undetected cancer cells remain in the body after surgery or irradiation. The use of anticancer drugs following surgery for early stage cancer is known as adjuvant therapy.

  Chemotherapy may be given by mouth or by injection into a muscle or a blood vessel. Chemotherapy is a systemic treatment - the drugs enter the bloodstream and reach cells all over the body. Depending on the specific drugs and the patient's general condition, chemotherapy may be taken as an outpatient - at the hospital, at the doctor's office, or at home. Sometimes, however, the person must be hospitalized for a time, so the effects of the treatment can be watched.

Side Effects of Treatment

The treatments used against cancer must be very powerful. That's why patients may have some unpleasant side effects. Many men worry that losing one testicle will affect their ability to have sexual intercourse or make them sterile. But a man with one healthy testicle can still have a normal erection and produce sperm. Therefore, an operation to remove just one testicle does not make a patient impotent and seldom interferes with fertility. Men can also have an artificial testicle, called a prosthesis, placed in the scrotum. The implant has the weight and feel of a normal testicle.

Surgery to remove the lymph nodes does not change a man's ability to have an erection or an orgasm, but the operation can cause sterility because it interferes with ejaculation. Some men recover the ability to ejaculate without treatment; others may be helped by medication. Patients should talk with the doctor about the possibility of removing the lymph nodes using a special surgical technique that may protect the ability to ejaculate.

Radiation therapy affects both normal and cancerous cells, but normal cells are able to recover. Having treatments 5 days a week for several weeks spreads out the total dose of radiation and gives the patient weekend rest breaks. Nevertheless, the body must work very hard during radiation therapy to repair the tissues injured by the treatment. Patients may feel unusually tired, and they should try to rest as much as possible. Radiation therapy does not change the ability to have sex. Radiation therapy does, however, interfere with sperm production. Usually the effect is temporary, and most patients regain their fertility within a matter of months.

Other unpleasant effects of radiation therapy include diarrhea, nausea, and vomiting. These problems can usually be controlled with medication. Also, there may be skin reactions in the area being treated, and it is important to treat the skin gently. Lotions and creams should not be used on these areas without the doctor's advice.

Chemotherapy causes side effects because it damages not only cancer cells, but other rapidly growing cells as well. Often anticancer drugs are given in cycles; treatment periods alternate with rest periods. The side effects of chemotherapy depend on the specific drugs that are given and the response of the individual patient. These drugs commonly affect hair cells, blood-forming cells, and cells that line the digestive tract. As a result, they may cause various problems, including hair loss, lowered resistance to infection, loss of appetite, nausea and vomiting, and mouth sores. Most men who receive chemotherapy for testicular cancer can continue to function sexually, although some anticancer drugs interfere with sperm production. Although this effect is permanent for some patients, many recover their fertility later on.

Loss of appetite can be a serious problem for patients receiving radiation therapy or chemotherapy. Researchers are learning that patients who eat well are better able to withstand the side effects of their treatment. Therefore, good nutrition is important. Eating well means getting enough calories to prevent weight loss and having enough protein to build and repair skin, hair, muscles, and organs. Many patients find that having several small meals and snacks throughout the day is easier than trying to eat three large meals.

The side effects of cancer therapy vary from person to person and may even be different from one treatment to the next. Patients may find that they are less interested in sexual activity if they are tired or feel ill. Doctors try to plan treatment to keep problems to a minimum, and fortunately, most side effects are temporary. Doctors, nurses, and dietitians can explain the side effects of cancer treatment and suggest ways to deal with them. Helpful information about cancer treatment and coping with side effects is given in the National Cancer Institute publications, Radiation Therapy and You, Chemotherapy and You, and Eating Hints.

Each year, Medical College of Wisconsin physicians care for more than 180,000 patients, representing nearly 500,000 patient visits. Medical College physicians practice at Children's Hospital of Wisconsin, Froedtert Memorial Lutheran Hospital, the Milwaukee VA Medical Center, and many other hospitals and clinics in Milwaukee and southeastern Wisconsin.